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adverse reactions
6 ADVERSE REACTIONS The following adverse reactions are described in greater detail in other sections: Severe skin and hypersensitivity reactions [ see Warnings and Precautions (5.1) ]. The most common adverse drug reactions of moderate to severe intensity (≥ 2%) which occurred at a higher rate than placebo are rash and peripheral neuropathy. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Tibotec Therapeutics at 1-877-REACH-TT or 1-877-732-2488 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety assessment is based on all data from 1203 subjects in the Phase 3 placebo-controlled trials, TMC125-C206 and TMC125-C216, conducted in antiretroviral treatment-experienced HIV-1-infected adult subjects, 599 of whom received INTELENCE ® (200 mg b.i.d.). In these pooled trials, the median exposure for subjects in the INTELENCE ® arm and placebo arm was 52.3 and 51.0 weeks, respectively. Discontinuations due to adverse drug reactions (ADRs) were 5.2% in the INTELENCE ® arm and 2.6% in the placebo arm. The most frequently reported ADR at least Grade 2 in severity was rash (10.0%). Stevens-Johnson syndrome, drug hypersensitivity reaction and erythema multiforme were reported in < 0.1% of subjects during clinical development with INTELENCE ® [ see Warnings and Precautions (5.1) ]. A total of 2.2% of HIV-1-infected subjects in Phase 3 trials receiving INTELENCE ® discontinued due to rash. In general, in clinical trials, rash was mild to moderate, occurred primarily in the second week of therapy, and was infrequent after Week 4. Rash generally resolved within 1-2 weeks on continued therapy. The incidence of rash was higher in women compared to men in the INTELENCE ® arm in the Phase 3 trials. Patients with a history of NNRTI-related rash did not appear to be at increased risk for the development of INTELENCE ® -related rash compared to patients without a history of NNRTI-related rash. Common Adverse Reactions Clinical ADRs of moderate intensity or greater (≥ Grade 2) and reported in ≥ 2% of subjects treated with INTELENCE ® and occurring at a higher rate compared to placebo (excess of 1%) are presented in Table 1. Laboratory abnormalities considered ADRs are included in Table 2. Table 1: Treatment-Emergent Adverse Reactions Includes adverse reactions at least possibly, probably, or very likely related to the drug. of at least Moderate Intensity Intensities are defined as follows: Moderate (discomfort enough to cause interference with usual activity); Severe (incapacitating with inability to work or do usual activity). (Grades 2-4) in ≥ 2% of Adult Subjects in the INTELENCE ® Treatment Groups and at a higher rate compared to placebo (excess of 1%) System Organ Class, Preferred Term, % Pooled TMC125-C206 and TMC125-C216 Trials INTELENCE ® + BR N=599 Placebo + BR N=604 N=total number of subjects per treatment group, BR=background regimen Nervous System Disorders Peripheral neuropathy 4% 2% Skin and Subcutaneous Tissue Disorders Rash 10% 3% Less Common Adverse Reactions Treatment-emergent ADRs occurring in less than 2% of subjects (n=599) receiving INTELENCE ® and of at least moderate intensity (≥ Grade 2) are listed below by body system: Cardiac Disorders : myocardial infarction, angina pectoris, atrial fibrillation Ear and Labyrinth Disorders : vertigo Eye Disorders : blurred vision Gastrointestinal Disorders : gastroesophageal reflux disease, flatulence, gastritis, abdominal distension, pancreatitis, constipation, dry mouth, hematemesis, retching, stomatitis General Disorders and Administration Site Conditions : sluggishness Hematologic Disorders : hemolytic anemia Hepatobiliary Disorders : hepatic failure, hepatomegaly, cytolytic hepatitis, hepatic steatosis, hepatitis Immune System Disorders : drug hypersensitivity, immune reconstitution syndrome Metabolism and Nutrition Disorders : diabetes mellitus, anorexia, dyslipidemia Nervous System Disorders : paraesthesia, somnolence, convulsion, hypoesthesia, amnesia, syncope, disturbance in attention, hypersomnia, tremor Psychiatric Disorders : anxiety, sleep disorders, abnormal dreams, confusional state, disorientation, nervousness, nightmares Renal and Urinary Disorders : acute renal failure Reproductive System and Breast Disorders : gynecomastia Respiratory,Thoracic and Mediastinal Disorders : exertional dyspnea, bronchospasm Skin and Subcutaneous Tissue Disorders : night sweats, lipohypertrophy, prurigo, hyperhidrosis, dry skin, swelling face Additional ADRs of at least moderate intensity observed in other trials were acquired lipodystrophy, angioneurotic edema, erythema multiforme and haemorrhagic stroke, each reported in no more than 0.5% of subjects. Laboratory Abnormalities in Treatment-Experienced Patients Selected Grade 2 to Grade 4 laboratory abnormalities that represent a worsening from baseline observed in adult subjects treated with INTELENCE ® are presented in Table 2. Table 2: Selected Grade 2 to 4 Laboratory Abnormalities Observed in Treatment-Experienced Subjects Pooled TMC125-C206 and TMC125-C216 Trials Laboratory Parameter Preferred Term, % DAIDS Toxicity Range INTELENCE ® + BR N=599 Placebo + BR N=604 ULN=Upper Limit of Normal, BR=background regimen GENERAL BIOCHEMISTRY Pancreatic amylase Grade 2 > 1.5-2 × ULN 7% 8% Grade 3 > 2-5 × ULN 7% 8% Grade 4 > 5 × ULN 2% 1% Lipase Grade 2 > 1.5-3 × ULN 4% 6% Grade 3 > 3-5 × ULN 2% 2% Grade 4 > 5×ULN 1% < 1% Creatinine Grade 2 > 1.4-1.8 × ULN 6% 5% Grade 3 > 1.9-3.4 × ULN 2% 1% Grade 4 > 3.4 × ULN 0% < 1% HEMATOLOGY Decreased hemoglobin Grade 2 90-99 g/L 2% 4% Grade 3 70-89 g/L < 1% < 1% Grade 4 < 70 g/L < 1% < 1% White blood cell count Grade 2 1,500-1,999/mm 3 2% 3% Grade 3 1,000-1,499/mm 3 1% 4% Grade 4 < 1,000/mm 3 1% < 1% Neutrophils Grade 2 750-999/mm 3 5% 6% Grade 3 500-749/mm 3 4% 4% Grade 4 < 500/mm 3 2% 3% Platelet count Grade 2 50,000-99,999/mm 3 3% 5% Grade 3 25,000-49,999/mm 3 1% 1% Grade 4 < 25,000/mm 3 < 1% < 1% LIPIDS AND GLUCOSE Total cholesterol Grade 2 > 6.20-7.77 mmol/L 240-300 mg/dL 20% 17% Grade 3 > 7.77 mmol/L > 300 mg/dL 8% 5% Low density lipoprotein Grade 2 4.13-4.9 mmol/L 160-190 mg/dL 13% 12% Grade 3 > 4.9 mmol/L > 190 mg/dL 7% 7% Triglycerides Grade 2 5.65-8.48 mmol/L 500 –750 mg/dL 9% 7% Grade 3 8.49-13.56 mmol/L 751 - 1200 mg/dL 6% 4% Grade 4 > 13.56 mmol/L > 1200 mg/dL 4% 2% Elevated glucose levels Grade 2 6.95-13.88 mmol/L 161-250 mg/dL 15% 13% Grade 3 13.89-27.75 mmol/L 251 – 500 mg/dL 4% 2% Grade 4 > 27.75 mmol/L > 500 mg/dL 0% < 1% HEPATIC PARAMETERS Alanine amino transferase Grade 2 2.6-5 × ULN 6% 5% Grade 3 5.1-10 × ULN 3% 2% Grade 4 > 10 × ULN 1% < 1% Aspartate amino transferase Grade 2 2.6-5 × ULN 6% 8% Grade 3 5.1-10 × ULN 3% 2% Grade 4 > 10 × ULN < 1% < 1% Patients co-infected with hepatitis B and/or hepatitis C virus In Phase 3 trials TMC125-C206 and TMC125-C216, 139 subjects (12.3%) with chronic hepatitis B and/or hepatitis C virus co-infection out of 1129 subjects were permitted to enroll. AST and ALT abnormalities occurred more frequently in hepatitis B and/or hepatitis C virus co-infected subjects for both treatment groups. Grade 2 or higher laboratory abnormalities that represent a worsening from baseline of AST, ALT or total bilirubin occurred in 27.8%, 25.0% and 7.1% respectively, of INTELENCE ® -treated co-infected subjects as compared to 6.7%, 7.5% and 1.8% of non-co-infected INTELENCE ® -treated subjects. In general, adverse events reported by INTELENCE ® -treated subjects with hepatitis B and/or hepatitis C virus co-infection were similar to INTELENCE ® -treated subjects without hepatitis B and/or hepatitis C virus co-infection. 6.2 Postmarketing Experience The following events have been identified during postmarketing use of INTELENCE ® . Because these events are reported voluntarily from a population of unknown size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Fatal cases of toxic epidermal necrolysis have been reported. Severe hypersensitivity reactions including cases of hepatic failure have been reported [ see Warnings and Precautions (5.1) ].
adverse reactions table
<table width="100%" ID="table2"> <caption>Table 2: Selected Grade 2 to 4 Laboratory Abnormalities Observed in Treatment-Experienced Subjects</caption> <col width="25%" align="left" valign="middle"/> <col width="25%" align="center" valign="middle"/> <col width="25%" align="center" valign="middle"/> <col width="25%" align="center" valign="middle"/> <thead> <tr styleCode="Botrule"> <th styleCode="Lrule Rrule"/> <th styleCode="Rrule"/> <th styleCode="Rrule" colspan="2">Pooled TMC125-C206 and TMC125-C216 Trials</th> </tr> <tr styleCode="Botrule"> <th styleCode="Lrule Rrule">Laboratory Parameter Preferred Term, %</th> <th styleCode="Rrule" valign="top">DAIDS Toxicity Range</th> <th styleCode="Rrule">INTELENCE<sup>®</sup> + BR N=599</th> <th styleCode="Rrule">Placebo + BR N=604</th> </tr> </thead> <tfoot> <tr> <td colspan="4" align="left">ULN=Upper Limit of Normal, BR=background regimen</td> </tr> </tfoot> <tbody> <tr> <td styleCode="Lrule Rrule"> <content styleCode="bold">GENERAL BIOCHEMISTRY</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule Botrule"/> </tr> <tr> <td styleCode="Lrule Rrule Toprule"> <content styleCode="bold">Pancreatic amylase</content> </td> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Botrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule Toprule">Grade 2</td> <td styleCode="Rrule Toprule">> 1.5-2 × ULN</td> <td styleCode="Rrule Toprule">7%</td> <td styleCode="Rrule">8%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">> 2-5 × ULN</td> <td styleCode="Rrule">7%</td> <td styleCode="Rrule">8%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 4</td> <td styleCode="Rrule">> 5 × ULN</td> <td styleCode="Rrule">2%</td> <td styleCode="Rrule">1%</td> </tr> <tr> <td styleCode="Lrule Rrule"> <content styleCode="bold">Lipase</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule Botrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule Toprule">Grade 2</td> <td styleCode="Rrule Toprule">> 1.5-3 × ULN</td> <td styleCode="Rrule Toprule">4%</td> <td styleCode="Rrule">6%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">> 3-5 × ULN</td> <td styleCode="Rrule">2%</td> <td styleCode="Rrule">2%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 4</td> <td styleCode="Rrule">> 5×ULN</td> <td styleCode="Rrule">1%</td> <td styleCode="Rrule">< 1%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule"> <content styleCode="bold">Creatinine</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 2</td> <td styleCode="Rrule">> 1.4-1.8 × ULN</td> <td styleCode="Rrule">6%</td> <td styleCode="Rrule">5%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">> 1.9-3.4 × ULN</td> <td styleCode="Rrule">2%</td> <td styleCode="Rrule">1%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 4</td> <td styleCode="Rrule">> 3.4 × ULN</td> <td styleCode="Rrule">0%</td> <td styleCode="Rrule">< 1%</td> </tr> <tr> <td styleCode="Lrule Rrule"> <content styleCode="bold">HEMATOLOGY</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule Botrule"/> </tr> <tr> <td styleCode="Lrule Rrule Toprule"> <content styleCode="bold">Decreased hemoglobin</content> </td> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Botrule"/> </tr> <tr> <td styleCode="Lrule Rrule Toprule">Grade 2</td> <td styleCode="Rrule Toprule">90-99 g/L</td> <td styleCode="Rrule Toprule">2%</td> <td styleCode="Rrule Botrule">4%</td> </tr> <tr> <td styleCode="Lrule Rrule Toprule">Grade 3</td> <td styleCode="Rrule Toprule">70-89 g/L</td> <td styleCode="Rrule Toprule">< 1%</td> <td styleCode="Rrule Botrule">< 1%</td> </tr> <tr> <td styleCode="Lrule Rrule Toprule">Grade 4</td> <td styleCode="Rrule Toprule">< 70 g/L</td> <td styleCode="Rrule Toprule">< 1%</td> <td styleCode="Rrule Botrule">< 1%</td> </tr> <tr> <td styleCode="Lrule Rrule Toprule"> <content styleCode="bold">White blood cell count</content> </td> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Botrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule Toprule">Grade 2</td> <td styleCode="Rrule Toprule">1,500-1,999/mm<sup>3</sup> </td> <td styleCode="Rrule Toprule">2%</td> <td styleCode="Rrule">3%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">1,000-1,499/mm<sup>3</sup> </td> <td styleCode="Rrule">1%</td> <td styleCode="Rrule">4%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 4</td> <td styleCode="Rrule">< 1,000/mm<sup>3</sup> </td> <td styleCode="Rrule">1%</td> <td styleCode="Rrule">< 1%</td> </tr> <tr> <td styleCode="Lrule Rrule Toprule"> <content styleCode="bold">Neutrophils</content> </td> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Botrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule Toprule">Grade 2</td> <td styleCode="Rrule Toprule">750-999/mm<sup>3</sup> </td> <td styleCode="Rrule Toprule">5%</td> <td styleCode="Rrule">6%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">500-749/mm<sup>3</sup> </td> <td styleCode="Rrule">4%</td> <td styleCode="Rrule">4%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 4</td> <td styleCode="Rrule">< 500/mm<sup>3</sup> </td> <td styleCode="Rrule">2%</td> <td styleCode="Rrule">3%</td> </tr> <tr> <td styleCode="Lrule Rrule"> <content styleCode="bold">Platelet count</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule Botrule"/> </tr> <tr> <td styleCode="Lrule Rrule Toprule">Grade 2</td> <td styleCode="Rrule Toprule">50,000-99,999/mm<sup>3</sup> </td> <td styleCode="Rrule Toprule">3%</td> <td styleCode="Rrule Botrule">5%</td> </tr> <tr> <td styleCode="Lrule Rrule Toprule">Grade 3</td> <td styleCode="Rrule Toprule">25,000-49,999/mm<sup>3</sup> </td> <td styleCode="Rrule Toprule">1%</td> <td styleCode="Rrule Botrule">1%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule Toprule">Grade 4</td> <td styleCode="Rrule Toprule">< 25,000/mm<sup>3</sup> </td> <td styleCode="Rrule Toprule">< 1%</td> <td styleCode="Rrule">< 1%</td> </tr> <tr> <td styleCode="Lrule Rrule"> <content styleCode="bold">LIPIDS AND GLUCOSE</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule Botrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule Toprule"> <content styleCode="bold">Total cholesterol</content> </td> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 2</td> <td styleCode="Rrule">> 6.20-7.77 mmol/L 240-300 mg/dL</td> <td styleCode="Rrule">20%</td> <td styleCode="Rrule">17%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">> 7.77 mmol/L > 300 mg/dL</td> <td styleCode="Rrule">8%</td> <td styleCode="Rrule">5%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule"> <content styleCode="bold">Low density lipoprotein</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 2</td> <td styleCode="Rrule">4.13-4.9 mmol/L 160-190 mg/dL</td> <td styleCode="Rrule">13%</td> <td styleCode="Rrule">12%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">> 4.9 mmol/L > 190 mg/dL</td> <td styleCode="Rrule">7%</td> <td styleCode="Rrule">7%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule"> <content styleCode="bold">Triglycerides</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 2</td> <td styleCode="Rrule">5.65-8.48 mmol/L 500 –750 mg/dL</td> <td styleCode="Rrule">9%</td> <td styleCode="Rrule">7%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">8.49-13.56 mmol/L 751 - 1200 mg/dL</td> <td styleCode="Rrule">6%</td> <td styleCode="Rrule">4%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 4</td> <td styleCode="Rrule">> 13.56 mmol/L > 1200 mg/dL</td> <td styleCode="Rrule">4%</td> <td styleCode="Rrule">2%</td> </tr> <tr> <td styleCode="Lrule Rrule"> <content styleCode="bold">Elevated glucose levels</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule Botrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule Toprule">Grade 2</td> <td styleCode="Rrule Toprule">6.95-13.88 mmol/L 161-250 mg/dL</td> <td styleCode="Rrule Toprule">15%</td> <td styleCode="Rrule">13%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">13.89-27.75 mmol/L 251 – 500 mg/dL</td> <td styleCode="Rrule">4%</td> <td styleCode="Rrule">2%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 4</td> <td styleCode="Rrule">> 27.75 mmol/L > 500 mg/dL</td> <td styleCode="Rrule">0%</td> <td styleCode="Rrule">< 1%</td> </tr> <tr> <td styleCode="Lrule Rrule"> <content styleCode="bold">HEPATIC PARAMETERS</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule Botrule"/> </tr> <tr> <td styleCode="Lrule Rrule Toprule"> <content styleCode="bold">Alanine amino transferase</content> </td> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Toprule"/> <td styleCode="Rrule Botrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule Toprule">Grade 2</td> <td styleCode="Rrule Toprule">2.6-5 × ULN</td> <td styleCode="Rrule Toprule">6%</td> <td styleCode="Rrule">5%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">5.1-10 × ULN</td> <td styleCode="Rrule">3%</td> <td styleCode="Rrule">2%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 4</td> <td styleCode="Rrule">> 10 × ULN</td> <td styleCode="Rrule">1%</td> <td styleCode="Rrule">< 1%</td> </tr> <tr> <td styleCode="Lrule Rrule"> <content styleCode="bold">Aspartate amino transferase</content> </td> <td styleCode="Rrule"/> <td styleCode="Rrule"/> <td styleCode="Rrule Botrule"/> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule Toprule">Grade 2</td> <td styleCode="Rrule Toprule">2.6-5 × ULN</td> <td styleCode="Rrule Toprule">6%</td> <td styleCode="Rrule">8%</td> </tr> <tr styleCode="Botrule"> <td styleCode="Lrule Rrule">Grade 3</td> <td styleCode="Rrule">5.1-10 × ULN</td> <td styleCode="Rrule">3%</td> <td styleCode="Rrule">2%</td> </tr> <tr> <td styleCode="Lrule Rrule">Grade 4</td> <td styleCode="Rrule">> 10 × ULN</td> <td styleCode="Rrule">< 1%</td> <td styleCode="Rrule">< 1%</td> </tr> </tbody> </table>